Asians In Singapore Research Articles

Will Absolute Risk Estimation for Time to Next Screen Work for an Asian Mammography Screening Population?

Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and 15-year) absolute risks in 28,234 asymptomatic Asian women. Absolute risks were calculated using different relative risk estimates and Breast cancer incidence and mortality rates (White, Asian-American, or the Singapore Asian population). Using linear models, we tested the association of absolute risk and age at breast cancer occurrence. Model discrimination was moderate (AUC range: 0.580-0.628). Calibration was better for longer-term prediction horizons (E/Olong-term ranges: 0.86-1.71; E/Oshort-term ranges:1.24-3.36). Subgroup analyses show that the model underestimates risk in women with breast cancer family history, positive recall status, and prior breast biopsy, and overestimates risk in underweight women. The Gail model absolute risk does not predict the age of breast cancer occurrence. Breast cancer risk prediction tools performed better with population-specific parameters. Two-year absolute risk estimation is attractive for breast cancer screening programs, but the models tested are not suitable for identifying Asian women at increased risk within this short interval.

Curating Shadows: Malayan Shadow Puppets in Singapore's Asian Civilisations Museum

Singapore's Asian Civilisations Museum houses a large collection of shadow puppets from Malaysia, but very little is known about them except that the originated in Kelantan during the period of British colonial rule. Scant records exist explaining how they ended up in the museum's ethnographic holdings, or the social significance of the collection for the museum and for Kelantanese theatrical arts. Examining the puppets through both an aesthetic and curatorial lens allows us to expand our knowledge of museology and cross-cultural encounters, and contributes to discussions on the interrelationship between history, the performing arts, and the politics of collecting at the periphery of colonial Malaya.

Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study

Although the EQ-5D questionnaire is widely used to measure health status internationally, there is little evidence of its content validity in Asian populations. This qualitative study aimed to explore the content validity of the EQ-5D in Singapore. Sixty Singaporeans (Chinese: 20; Malay: 20; Indian: 20) completed semi-structured interviews in which they were asked about health concepts which were important to them and the relevance and comprehensiveness of the EQ-5D descriptive system (DS). Thematic analysis employing open, focused and axial coding was used to identify the themes and subthemes from the interviews. A total of 70 health concepts were identified which fall into the broad categories of 'physical health', 'mental well-being', 'social relationships', 'medical conditions and treatment', and 'health promotion knowledge and behaviours'. The 5 dimensions in the EQ-5D DS were among the health concepts nominated by participants. Some participants suggested that content validity could be improved by adding social relationships, medical conditions and treatment, and health promotion knowledge and behaviours to the EQ-5D DS. This study confirmed that EQ-5D dimensions are important and relevant aspects of health to Asians in Singapore, although some dimensions that could be important to Singaporeans are absent.

Cultural Determinants of Cancer Fatalism and Cancer Prevention Behaviors among Asians in Singapore

ABSTRACT This research aims to better understand cultural disparities in cancer prevention behaviors. To do this, we investigate how four cultural beliefs – optimism, pessimism, naïve dialecticism, and superstition – associate with cancer fatalism, which has been recognized as a major barrier to cancer prevention behaviors. Based on an online survey of 1,021 Singapore residents, the results reveal that cancer fatalism is positively associated with pessimism, naïve dialecticism and superstitions, and associated negatively with optimism. Mediation analyses further reveal that cancer fatalism is a significant mediator between these four cultural beliefs and four cancer prevention behaviors including fruit and vegetable intake, regular exercise, avoidance of smoking, and sunscreen use. This study offers theoretical insights into the understanding of how people develop cancer fatalism and practical guidance on the promotion of cancer prevention behaviors, particularly among Asian populations.

PAX4 R192H is associated with younger onset of Type 2 diabetes in East Asians in Singapore

AimsYoung-onset T2D (YT2D) is associated with a more fulminant course and greater propensity for diabetic complications. The association of PAX4 R192H (rs2233580) variation with YT2D was inconsistent partly because of its Asian-specificity and under-representation of Asians in international consortiums. Interestingly, in our preliminary YT2D (mean = 25 years old) cohort, the prevalence of PAX4 R192H variant was remarkably higher (21.4%) than the general population. Therefore, we sought to determine whether PAX4 R192H is associated with younger onset of T2D in our East Asian (Chinese) population. MethodsGenotyping of PAX4 R192H was carried out using Illumina OmniExpress BeadChips as part of a genome-wide association study. Data analysis was performed using SPSS Ver. 22. ResultsPAX4 R192H genotype was associated with younger onset age (CC: 47.1, CT: 46.0, TT: 42.6) after adjusting for gender, F = 5.402, p = 0.005. Independently, onset of diabetes was younger among males by 2.52 years, 95% CI [−3.45, −1.59], p < 0.0001. HOMA-IR and HOMA-%B were not significantly different across genotypes for a subset (n = 1045) of the cohort. ConclusionsMinor allele (T) of PAX4 R192H is associated with younger onset diabetes among Chinese in Singapore. Determining this genotype is important for identifying at-risk individuals for earlier onset diabetes and diabetic complications.

Cultural Effects on Cancer Prevention Behaviors: Fatalistic Cancer Beliefs and Risk Optimism Among Asians in Singapore

ABSTRACTAlthough culture is acknowledged as an important factor that influences health, little is known about cultural differences pertaining to cancer-related beliefs and prevention behaviors. This study examines two culturally influenced beliefs—fatalistic beliefs about cancer prevention, and optimistic beliefs about cancer risk—to identify reasons for cultural disparity in the engagement of cancer prevention behaviors. We utilized data from national surveys of European Americans in the United States (Health Information National Trends Survey 4, Cycle3; N = 1,139) and Asians in Singapore (N = 1,200) to make cultural comparisons. The odds of an Asian adhering to prevention recommendations were less than half the odds of a European American, with the exception of smoking avoidance. Compared to European Americans, Asians were more optimistic about their cancer risk both in an absolute and a comparative sense, and held stronger fatalistic beliefs about cancer prevention. Mediation analyses revealed that fatalistic beliefs and absolute risk optimism among Asians partially explain their lower engagement in prevention behaviors, whereas comparative risk optimism increases their likelihood of adhering to prevention behaviors. Our findings underscore the need for developing culturally targeted interventions in communicating cancer causes and prevention.

Prevalence of sleep-disordered breathing in a multiethnic Asian population in Singapore: A community-based study.

Limited data exist on the prevalence variation in sleep-disordered breathing (SDB) across different Asian ethnicities. This population study aimed to estimate the prevalence of SDB in Singapore, a multiethnic nation, and to quantify the prevalence variation among Chinese, Malays and Indians. The Singapore Health Study 2012 was a cross-sectional population study conducted on adults aged 21-79 years. Among 2329 participants who completed baseline examination, a sample of 242 subjects completed home-based sleep testing with an Embletta device (type 3 monitor). Moderate-to-severe SDB, defined as an apnoea-hypopnoea index (AHI) of ≥15 events/h, was used to estimate prevalence. The weighted estimates of the population prevalence of moderate-to-severe SDB and sleep apnoea syndrome were 30.5% and 18.1%, respectively. Of subjects with AHI ≥15, 91.0% were previously undiagnosed. Moderate-to-severe SDB prevalence varied across the Chinese (32.1%), Malays (33.8%) and Indians (16.5%). The mean body mass index (BMI) was lowest in Chinese (23.3 kg/m(2) ) and highest among Malays (26.0 kg/m(2) ) and Indians (25.4 kg/m(2) ). Compared with Chinese, Indians had lower odds of moderate-to-severe SDB after adjustment for age, sex and BMI (odds ratio 0.82, 95% CI: 0.70-0.96, P = 0.02). Sleep-disordered breathing is prevalent but mostly undiagnosed among Asians in Singapore. There was a lower prevalence of SDB among Indians compared with Chinese that remained after adjustment for age, sex and BMI. Strategies are needed to optimize diagnosis and recognize ethnic differences in SDB prevalence.

Interpretation and use of the 5-level EQ-5D response labels varied with survey language among Asians in Singapore

ObjectivesThis study aimed to investigate the comparability of the English, Chinese, and Malay versions of the 5-level EQ-5D (EQ-5D-5L) response labels in Singapore. Study Design and SettingVisitors to a primary care institution in Singapore (n = 743) were asked to complete two exercises: (1) rating the severity of the EQ-5D-5L response labels presented in English, Chinese, or Malay using a 0–100 numeric rating scale and (2) using the labels to describe various hypothetical health problems. Label ratings and choices between language versions were compared using regression analysis. ResultsPerceived severity of the English and Chinese labels was similar. Compared with their English counterparts, the Malay label “slight(ly)” was rated as more severe (adjusted mean difference: 10.5 to 14.5) and “unable”/“extreme(ly)” as less severe (adjusted mean difference: −13.3 to −11.0) (P < 0.001 for all). The Malay labels “no(t)” and “unable”/“extreme(ly)” and the less severe Chinese labels were more frequently used to describe hypothetical health problems than their English counterparts. ConclusionInterpretation and use of the EQ-5D-5L response labels vary among Singaporeans using different language versions of the instrument. Future studies need to investigate ways to reduce the variations and increase the cross-cultural measurement equivalence of the instrument.

Cross-cultural measurement equivalence of the EQ-5D-5L items for English-speaking Asians in Singapore.

To investigate how the response labels of the 5-level EQ-5D (EQ-5D-5L) items are interpreted and used by English-speaking Chinese and non-Chinese Singaporeans, as a means to assessing whether those items are cross-culturally equivalent health-status measures in this Asian population. In face-to-face interviews, Chinese, Malay and Indian visitors to a primary care institution in Singapore were asked to rate the relative severity conveyed by EQ-5D-5L response labels, each containing the keyword of 'no(t),' 'slight(ly),' 'moderate(ly),' 'severe(ly),' or 'unable'/'extreme(ly),' using a 0-100 numerical rating scale. Participants were also asked to describe 25 hypothetical health states using the EQ-5D-5L response labels. Differences between Chinese and Malay/Indian participants in label interpretation and selection were examined using multivariate regression analysis to adjust for participant characteristics. The differences in adjusted mean severity scores for individual EQ-5D-5L labels between Chinese (n = 148) and non-Chinese (Malay: n = 53; Indian: n = 56) participants ranged from 0.0 to 9.0. The relative severity of the labels to the participants supported the ordinality of the EQ-5D-5L response labels and was similar across ethnic groups. Chinese and non-Chinese participants selected similar response labels to describe each hypothetical health state, with the adjusted odds ratios of selecting any type of the five response labels for non-Chinese versus Chinese participants ranging from 0.92 to 1.15 (p > 0.05 for all). The EQ-5D-5L items are likely to generate equivalent health outcomes between English-speaking Chinese and non-Chinese Singaporeans.

Does diabetes have an impact on health-state utility? A study of asians in singapore.

Objective Our objective was to compare the time trade-off (TTO) values of EQ-5D-3L health states elicited from Singaporeans with and without type 2 diabetes mellitus (T2DM) and T2DM patients with and without complications.

Health Burden Associated with Visual Impairment in Singapore: The Singapore Epidemiology of Eye Disease Study

To assess the impact of visual impairment (VI) on health-related quality of life and to compare the health burden of VI and other health conditions in Singapore. Population-based cross-sectional study. We studied the 10 009 adults (3353 Chinese, 3397 Indians, and 3259 Malays) who underwent a comprehensive eye assessment and completed the European Quality of Life-5 Dimensions (EQ-5D) questionnaire in the Singapore Epidemiology of Eye Disease Study. We estimated the effects of VI, obesity, hypertension, diabetes, and hyperlipidemia on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. We compared prevalence-based quality-adjusted life-year (QALY) loss associated with VI and other health conditions. For each condition, QALY loss was calculated for 100 000 persons in 1 year using associated reduction in EQ-5D index score estimated in regression analysis as disutility. The EQ-5D index score and annual QALY loss. The EQ-5D index score decreased with increasing VI severity in all 3 ethnicities. For example, after adjusting for sociodemographic characteristics, the difference in EQ-5D index score between adults with bilateral severe VI and those without VI was -0.044 (95% confidence interval [CI], -0.089 to 0.001) in Chinese, -0.127 (95% CI, -0.237 to -0.017) in Indians, and -0.085 (95% CI, -0.148 to -0.022) in Malays. In all 3 ethnicities, VI was associated with reporting of problems in mobility (e.g., odds ratio [OR], 3.69 for Chinese with bilateral severe VI; 95% CI, 1.21-12.13) and usual activities (e.g., OR, 6.51 for Chinese with bilateral severe VI; 95% CI, 1.59-26.58). In Indians, VI was also associated with anxiety or depression (e.g., OR, 2.68 for bilateral severe VI; 95% CI, 1.11-6.50). The annual QALY loss associated with VI was 511.8 in Chinese, 608.8 in Indians, and 706.7 in Malays, greater than that associated with other health conditions examined in this study. Visual impairment is associated with substantial health burden among Asians in Singapore. The relatively high burden of VI highlights the importance of VI prevention. The ethnic difference exhibited in this burden warrants further study.

Does diabetes have an impact on health-state utility? a study of Asians in Singapore.

Our objective was to compare the time trade-off (TTO) values of EQ-5D-3L health states elicited from Singaporeans with and without type 2 diabetes mellitus (T2DM) and T2DM patients with and without complications. The TTO values of ten EQ-5D-3L health states were elicited from a consecutive sample of T2DM patients and a general Singaporean population sample using similar valuation protocols. In face-to-face interviews, T2DM patients and members of the general population were asked to value five and ten health states, respectively. The difference in TTO values between the two samples and between T2DM patients with and without complications was examined using multiple linear regression models. A total of 109 T2DM patients and 46 individuals without T2DM provided data. All ten health states considered, the mean TTO value was -0.02 for the general population sample and -0.04 for T2DM patients, with the unadjusted and adjusted difference being -0.06 (95 % confidence interval [CI] -0.16, 0.03) and 0.02 (95 % CI -0.12, 0.15). The general population sample had systematically lower TTO values for mild health states, with the adjusted difference being -0.13 (95% CI -0.25, -0.02); while the two samples had similar TTO values for severe health states, with the adjusted difference being 0.02 (95% CI -0.16, 0.19). T2DM patients without complications had systematically lower TTO values than those with complications, with the adjusted difference being -0.10 (95% CI -0.23, 0.03). It appears that diabetes and its complications affect patients' valuation of health states. Hence, the EQ-5D-3L health-state values based on the general population may underestimate the utility of health interventions for T2DM.

Encountering Asia

This article explores the narratives of Filipino medical workers on their encounters with other Asians during their migrant journeys to Singapore. Migrants speak of their encounters with regional cultural diversity and the everyday manifestations of regional political-economic power configurations and inequalities. The narratives show that beyond merely responding to state discourses on how migrants ought to represent the nation-state abroad, migrants attempt, on their own terms, to understand their place in Asia, and the world. Their journeys take place at a moment of social and demographic change as many Filipino medical workers travel across borders to care for aging populations in other Asian countries. The field of care raises complex moral dilemmas for Asians of different ethnic and national backgrounds, and this complicates any simple notion of Asian values. Moments of pan-Asian solidarity, in which friendships are cultivated across national boundaries, are often overridden by experiences of racial and cultural prejudice. Among diverse Asians in Singapore, divisive and hierarchical notions of first world and third world, modern and backward, caring and uncaring are prevalent in everyday judgments of others. Filipino migrants assert their global aspirations and their moral reflections on how to live and care for others; simultaneously they create distance from those who they believe do not share such aspirations and moral views. This article illuminates the transformations in migrant subjectivities as migrants experience and evaluate a range of cultural encounters as medical carers in the region.

Guangzhou 2010: Singapore at a Global Crossroads

This essay is an analysis of the reality of Singapore's Asian Games' aspirations and achievements and the responses to the challenges it faced in Guangzhou in 2010. How did ‘Team Singapore’ respond to the challenges that they met at what represented a crossroad in their sporting history at which they met the vehicle carrying China's sporting and soft power products. How did they react and were the effort, industry, hyperbole and not insignificant government financial outlay and policy initiatives worth it? The analysis constitutes a critique of articles relating to the Guangzhou Asian Games of 2010 that appeared in the three major English language newspapers in Singapore, The Straits Times, The Sunday Times and The New Paper before, during and after the Games. From the analysis, major themes emerged which characterised the environment of elite sport in Singapore and revealed that it is very much part of the nation's inimitable social, political and diplomatic schema; sport, as with all other socio-cultural institutions in Singapore, has not and does not evolve accidentally.

Making sense of a mélange: Representing Cultural Citizenship in Singapore's Asian Civilisations Museum

AbstractMuseums around the globe are increasingly being employed to expand the practice and experience of cultural citizenship, interpreting cross‐cultural connections as key to civic identity and pride. This article is an ethnographic case study of how two museums represent different visions of cultural citizenship in the ethnically diverse nation of Singapore. Viewing exhibitions as texts and drawing on interviews and interactions with museum staff, visitors, and community members as well as observations made within the museum environment, this research suggests that the two branches of Singapore's Asian Civilisations Museum—the new “Peranakan Museum” and the Empress Place Museum—can be seen as tools that are central to the promotion of government agendas of nation building and cultural citizenization in Singapore. In this article, I analyze them in terms of their embodiment of “traditional” versus “post” multicultural characteristics. [national museums, identity, postcolonialism, multiculturalism, Peranakans, Singapore]

Making a Case for the Socioeconomic Determinacy of Survival in Osteosarcoma

The literature on osteosarcoma survival generally focuses on tumor and treatment variables, although it is unclear whether and how ethnic and socioeconomic factors might influence survival. We therefore investigated the relative contribution of socioeconomic influences together with more traditional tumor-specific factors on osteosarcoma survival. We performed survival analyses on two national databases in two countries. Using multivariable analyses, we compared these with corresponding institution-specific survival to determine if socioeconomic factors might impact osteosarcoma survival. East Asian descent, state-specific treatment, female sex, treatment in the 1990s, low-grade disease, intracompartmental disease, small size, wide resections as opposed to forequarter or hindquarter amputations, and single primaries were good prognostic factors. Survival was better in the more affluent states. Males were affected at an older age than females. Blacks tended to have larger tumors, although their overall survival was similar to whites. East Asians were more likely to be treated in the 1990s with wide resections for smaller tumors and were located around states associated with good treatment. East Asians in Singapore and the United States had the same survival. Survival in East Asians in Singapore was similar to that of other races. The provision of health care for osteosarcoma varies greatly across the United States but is uniform in the socialized medical system in Singapore. Hence, the observed differences in the United States were likely the result of socioeconomic factors. Our analysis suggests ethnic and economic bias may influence survival in osteosarcoma and should receive greater attention in the collective literature on survival analyses. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Clinicopathologic study of solar dermatitis, a pinpoint papular variant of polymorphous light eruption in Taiwan, and review of the literature

A mild, micropapular eruption previously coined as "solar dermatitis" on the extensor of the forearm is a common form of photodermatitis in Taiwan. This study aimed to investigate the clinicopathologic findings of "solar dermatitis", the micropapular type of photodermatitis. We characterized the features of this photodermatitis by retrospectively reviewing and analyzing all such cases in a medical center in Southern Taiwan diagnosed during October 1988 to November 2010. A total of 34 Taiwanese patients, all with Fitzpatrick skin type III-IV, were included (M:F = 1:1; mean age = 33.5 years; range = 9-62 years). Patients typically presented numerous, monomorphous, pinhead-sized micropapules on the extensor of the forearm after a recent, more intense sun exposure. The rash was often mildly pruritic and recurred in the summer, but usually resolved in a few days after sun protection and topical corticosteroid treatment. Reduced minimal erythema dose to UVB was noted in 2 of the 5 patients tested. Histopathologic examination (n = 10) revealed a mild spongiotic dermatitis. The clinicopathologic findings of the "solar dermatitis" closely resembled those of the pinpoint papular variant of polymorphous light eruption (PP-PMLE) affecting African Americans and Asians in Singapore. PP-PMLE, micropapular light eruption in Japanese, summertime actinic lichenoid eruption in Indians and the present photodermatitis might represent a common, micropapular variant of PMLE affecting darker skin populations.

Quit Now! A Psychoeducational Expressive Therapy Group Work Approach for At-Risk and Delinquent Adolescent Smokers in Singapore

In this article, we review the risk and protective factors for adolescent smoking, as well as current research on evidence-based practices. The relevance of structured expressive therapy in meeting the maturational and emotional needs of at-risk and delinquent adolescents, and the multicultural context of adolescents in Singapore's Asian society are also explored. We present a framework for an evidence-based psychoeducational structured expressive therapy group work model which was pioneered in Singapore residential rehabilitation programs and high schools under the auspices of CARE Singapore.

Response to Letter by Sheikh

Response: We appreciate the comments by Dr Sheikh. In our research letter,1 we studied the prevalence and associations of intracranial large-artery disease (ICLAD) among ethnic South Asians in Singapore. The cited reference “Global burden of intracranial atherosclerosis”2 for the statement reading “ICLAD is the most common vascular lesion in stroke worldwide” was published in the International Journal of Stroke , the official journal of the World Stroke Organization (WSO), edited by Prof Geoffrey Donnan, current president of the WSO. It is not registered with PubMed Central as its first issue was only published in February …

Psychometric evaluation of the Schizophrenia Quality of Life Scale (SQLS) in English- and Chinese-speaking Asians in Singapore

To assess the psychometric properties of the Schizophrenia Quality of Life Scale (SQLS) in Asians with schizophrenia in Singapore. A consecutive sample of outpatients with schizophrenia completed the English or Chinese version of the SQLS and the Short-Form 36 Health Survey (SF-36) twice during two different clinic visits. The patients were also assessed for presence or absence of 22 psychiatric symptoms. About 202 patients (English-speaking: 140) participated in the study. Correlations between SQLS scales and other measures assessing similar constructs ranged from 0.46 to 0.69 (P < 0.001 for all). For SQLS psychosocial and symptoms/side effects scales, item-to-scale correlations were >0.4, Cronbach's alpha and intra-class correlation coefficient values were close to or exceed 0.7, and Cohen's effect size, standardized response mean, and Guyatt's responsiveness index values approximated or exceeded 0.2 for both SQLS language versions; however, for the energy/motivation scale, item-to-scale correlations (range: 0.08-0.51), reliability (range: 0.46-0.66) and responsiveness (range: 0.04-0.08) statistics were not satisfactory for both SQLS versions. The SQLS psychosocial and symptoms/side effects scales are valid, reliable and responsive in Singaporean patients with schizophrenia; the appropriateness of energy/motivation scale requires further investigation.